Senior Client Services Representative
2 weeks ago
Immediate need for a talented Administrative Assistant. This is a 06+ months Contract opportunity with long-term potential and is located in 2110 N UNION STREET Middletown PA(Onsite). Please review the job description below and contact me ASAP if you are interested.Job ID: 23-30470Pay Range: $17.60/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).Key Responsibilities: Provides prompt, accurate, thorough and courteous responses to all complex inquiries from Medicare Advantage members and providers. Inquiries are typically non-routine and require deviation from standard screens, scripts, government websites and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or specialty Medicare claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational and govemental policies and procedures. 40% Reviews claims or appeals issues, complaints, and inquiries referred by Member Services Representative to determine if desk procedures and federal guidelines were followed. Researches to identifying underlying causes and determines ways to prevent and correct such causes. Identifies and reports potential fraud and abuse situations. Responds to complex Medicare Part C and Part D questions, ensures CMS coordination of benefit reconciliation is accurate, and answers escalated provider inquires. 20% Researches and responds to complex customer inquiries, ensuring that contract standards and Federal and organizational objectives for timeliness, productivity, and quality are met. Handles situations that require adaptation of response or extensive research. 20% Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards, and examining federal guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards. 10% Provides feedback to management regarding escalated customer issues. Maintains accurate records concerning issues. Follows through on complaints until resolved or report to management as needed. 10% Maintains knowledge of procedures and policies. Assists with process improvements by recommending improvements in procedures and policies. Assists in training client services representatives.Key Requirements and Technology Experience: Good verbal and written communication skills. Strong customer service skills. Good spelling, punctuation, and grammar skills. Basic business math abilities. Ability to handle confidential or sensitive information with discretion. Microsoft Office Work Environment: Typical office environment. High school diploma or equivalency. Overall understanding of CMS enrollment, disenrollment policies; Must understand CMS Part D Drug Manual and processing guidelines to respond to pharmacy-related questions; Must understand ITS rule and regulations; Must understand ever-changing supplemental benefits such as: dental, vision, fitness, over-the-counter, hearing, and telehealth; Must be knowledgeable of medical management processes to include: investigating gap closures, at-home diabetic testing, and at-home colon screenings. 3 years of customer service experience,including 1 year of claims or appeals processing experience; Bachelor's degree in lieu of work experience.Our client is a leading Insurance industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.#cha
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Client Care Manager
2 weeks ago
Columbia, United States RetireEASE Senior Services Full time $42,000 - $55,000Job DescriptionJob DescriptionWe are looking for a dynamic self-starter to be our Client Care Manager to join our award-winning Home Care agency.Someone who will grow our client base, foster a "Team Approach" with care staff and maintain our high standards of client care.Our ideal candidate is excited, energetic, dedicated, and a self-starter, as well as has...
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Client Services Representative
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Columbia, South Carolina, United States Emerge Professional Full timeExciting Career Opportunity in the Insurance SectorEmerge Professional is collaborating with a reputable firm committed to guiding clients through the complexities of the insurance landscape. With over twenty years of established relationships, they provide a streamlined experience with attractive pricing.Position: Medicare Sales RepresentativeLocation:...
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Health Services Manager
2 weeks ago
Columbia, United States RetireEASE Senior Services Full time $42,000 - $55,000Job DescriptionJob DescriptionWe are looking for a dynamic self-starter to be our Health Services Manager to join our award-winning Home Care agency.Someone who will grow our client base, foster a "Team Approach" with care staff and maintain our high standards of client care.Our ideal candidate is excited, energetic, dedicated, and a self-starter, as well as...
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Columbia, United States TalentWealth Full timeTalentWealth Recruiting , a boutique financial services recruiting firm, is recruiting for an exciting opportunity. An independent wealth management firm with over $200MM AUM based in Columbia, MD is hiring for a Senior Client Service Associate with experience in all areas of client and advisor support to join a successful and growing wealth management...
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Columbia, United States TalentWealth Full timeTalentWealth Recruiting, a boutique financial services recruiting firm, is recruiting for an exciting opportunity. An independent wealth management firm with over $200MM AUM based in Columbia, MD is hiring for a Senior Client Service Associate with experience in all areas of client and advisor support to join a successful and growing wealth management...
